Being Old in a Democracy

So we really do have an aging society. The good news, as I’ve said before, is that we’re living longer, on average, than ever before. The bad (some say) is that we have fewer children.

These are the best and worst times to be old. Medical care, of course, is better than ever. Sophisticated and prosperous people know better how to take care of themselves, and they’re taking responsibility, maybe like never before, for their health and safety. For some, seventy really is the new fifty.

But, as Socrates first explained in Plato’s Republic, democracies in particular have trouble figuring out what old people are for.

Democracy, said Socrates, is all about freedom or the absence of compulsion. If all people are equal, then all desires and ways of life are equal. So the moral principle of democracy is nonjudgmentalism.

The ranking part of the soul Socrates calls spiritedness. People angrily or at least seriously demand personal significance, and they pursue it through various forms of excellence or demanding self-restraint. They want to be more than their desires, or at least they want to rank their desires according to some higher principle or purpose.

Spiritedness or pride democrats call repression. They liberate desire from spiritedness, and so they, according to Socrates, become deeply pro-choice when it comes to everything people think and do.

That means the democratic life claims to be free from the obsessions of order and necessity. Democrats claim to be free to do whatever they want whenever they want. They understand their lives as a series of hobbies, without the order and direction that come from love and death, and so from productivity, parenthood, citizenship, community, friendship, truth, and self-defense.

The same freedom of the democratic way of life Socrates describes Marx describes as communism in The German Ideology. The difference between Socrates and Marx is that the latter took his description seriously as perfectly desirable and as our more or less inevitable future—a world in which religion, the state, the family, and so forth would have withered away.

For Socrates, pure democracy is in some respects desirable and in others ugly self-denial, and he was clear enough that it’s unsustainable in real life. From his point of view, we should be worried that our way of life become too democratic, meaning too comprehensively pro-choice or too promiscuously libertarian.

The cure to what ails democracy is usually less democracy. That means the cure is more oligarchy (or disciplined concern for the production of wealth), more timocracy (or high-minded concern for honor or nobility), and more aristocracy (or more concern for merit, excellence, or the rule of wisdom). Every real democratic country counts on being mixed with these undemocratic “regimes” for its security and moral goodness.

The ugliness of democracy is its unrealistic denial of the inevitability and even the goodness of personal death and personal authority. The easiest and maybe the truest criticism of Marxism is about its idea that capitalism—or liberated techno-productivity—could ever overcome natural scarcity. The scarcity that always remains is scarcity of time. Under communism, people will remain self-conscious and mortal.

That means they will remain to some extent obsessive and repressed, and they’ll be stuck with ranking their activities or choices with the scarcity of time (if nothing else) in mind.

So in a democracy, young people are particularly repulsed by old people. They remind them of death, the death that comes to us all. As Socrates explains and we observe, in a democracy the old do everything they can to look young and imitate the ways of the young. They do everything they can not to be disagreeable or unpleasant. That’s why, in our time, they nip, tuck, botox, and so forth.

And they don’t get any respect. Nobody believes, in a democracy, that wisdom comes with age, and, in any case, nobody respects wisdom or even the “truth.” The same goes with the authority that comes from tradition or with family. Old people become nothing but inferior young people, people, unlike the young, in so many ways obviously limited and diminished by necessity. That’s why we’re increasingly about warehousing the very old where we can’t see them.

In a democracy, Socrates says and we observe, experienced teachers fawn over their pupils,and we become accustomed to the absurdity that students are qualified to evaluate their teachers.

The ugliness of the democracy is displayed in its denial of the wisdom that comes with age, in its denial that being old will happen to us all (if we’re lucky). So the ugliness of democracy is displayed in finding no truth or beauty in being old.

Socrates, we remember, almost begins The Republic by asking an old man what it’s like to be old. And he seems to learn that there’ s little worse than being old and poor in a democracy. A downside of being old in America today is that people have more and more reason to fear that their money won’t last as long as they do.

Still, being old in a democracy is a problem that more people than ever are lucky to have.  We have to think more clearly about the virtues required to live well with being very old.  The studies actually show that being loved is more important, even when it comes to medical outcomes, than being rich.

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Yale scientists restore brain function to 32 clinically dead pigs

Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

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  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
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The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. Think a dialysis machine for the mind. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.